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  1. Article ; Online: Insomnia medications: History, characteristics, and guidelines for optimal use in clinical practice.

    Krystal, Andrew D

    Journal of sleep research

    2023  Volume 32, Issue 6, Page(s) e14084

    Abstract: This article reviews the history of insomnia pharmacotherapy, documenting the evolution that has occurred over time in the increasing availability of medications with novel mechanisms of action that more specifically target the neural systems that ... ...

    Abstract This article reviews the history of insomnia pharmacotherapy, documenting the evolution that has occurred over time in the increasing availability of medications with novel mechanisms of action that more specifically target the neural systems that modulate sleep/wake function. This evolution provides an increasing capacity to improve the effectiveness of insomnia pharmacotherapy by allowing the selection of medications that specifically target the particular type of sleep difficulty present in each patient. As a result, they can achieve a therapeutic effect with fewer effects on aspects of brain function other than those needed to achieve benefit, thereby minimising adverse effects. The accumulated evidence-base is such that it can serve as the basis for a personalised insomnia pharmacotherapy paradigm. Here we outline a set of best-practice recommendations for how to carry out optimised personalised insomnia pharmacotherapy based on that evidence base in the hope that it will improve the treatment delivered to the many individuals suffering from insomnia.
    MeSH term(s) Humans ; Sleep Initiation and Maintenance Disorders/drug therapy ; Sleep
    Language English
    Publishing date 2023-11-08
    Publishing country England
    Document type Review ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1122722-9
    ISSN 1365-2869 ; 0962-1105
    ISSN (online) 1365-2869
    ISSN 0962-1105
    DOI 10.1111/jsr.14084
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  2. Article ; Online: Optimizing Treatment for Insomnia.

    Krystal, Andrew D

    The Journal of clinical psychiatry

    2021  Volume 82, Issue 4

    Abstract: By tailoring the mechanism of action and effects of therapy to the specific nature of each patient's insomnia and other conditions, clinicians can offer personalized care in an attempt to achieve an improved risk-benefit ratio compared to that of a "one- ... ...

    Abstract By tailoring the mechanism of action and effects of therapy to the specific nature of each patient's insomnia and other conditions, clinicians can offer personalized care in an attempt to achieve an improved risk-benefit ratio compared to that of a "one-size-fits-all" treatment strategy. To move toward this personalization and optimization of treatment, clinicians need awareness of the specific effects of interventions and the subpopulations with insomnia who would benefit from each intervention. This report reviews insomnia treatments, focusing on effects associated with mechanism of action.
    Language English
    Publishing date 2021-07-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 716287-x
    ISSN 1555-2101 ; 0160-6689
    ISSN (online) 1555-2101
    ISSN 0160-6689
    DOI 10.4088/JCP.EI20008BR4C
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  3. Article ; Online: Challenges in Managing Insomnia in Older People.

    Krystal, Andrew D

    The Journal of clinical psychiatry

    2021  Volume 82, Issue 4

    Abstract: Older people often experience insomnia, whether it is difficulty initiating or maintaining sleep. These sleep disturbances have a negative impact on quality of life and functioning. This report offers general considerations as well as specific data ... ...

    Abstract Older people often experience insomnia, whether it is difficulty initiating or maintaining sleep. These sleep disturbances have a negative impact on quality of life and functioning. This report offers general considerations as well as specific data related to managing insomnia in older adults, including a brief review of treatment options with an emphasis on their tolerability profiles.
    Language English
    Publishing date 2021-06-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 716287-x
    ISSN 1555-2101 ; 0160-6689
    ISSN (online) 1555-2101
    ISSN 0160-6689
    DOI 10.4088/JCP.EI20008BR3C
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  4. Article ; Online: Omitted Conflict of Interest Disclosures.

    Krystal, Andrew D

    JAMA psychiatry

    2020  Volume 77, Issue 7, Page(s) 768

    MeSH term(s) Cognitive Behavioral Therapy ; Conflict of Interest ; Disclosure ; Female ; Humans ; Pregnancy ; Pregnant Women ; Sleep Initiation and Maintenance Disorders
    Language English
    Publishing date 2020-04-22
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2701203-7
    ISSN 2168-6238 ; 2168-622X
    ISSN (online) 2168-6238
    ISSN 2168-622X
    DOI 10.1001/jamapsychiatry.2020.0616
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  5. Book ; Conference proceedings: Understanding the sleep wake cycle

    Krystal, Andrew D. / Benca, Ruth M. / Kilduff, Thomas S.

    sleep, insonmia, and the Orexin system ; academic proceedings ; [derived from the Planning Roundtable Teleconference "Understanding the Sleep-Wake Cycle: Sleep, Insonmia, and the Orexin System," which was held on May 24, 2013]

    (The journal of clinical psychiatry ; 74, Suppl. 1)

    2013  

    Title variant Understanding the sleep-wake cycle
    Event/congress Planning Roundtable Teleconference Understanding the Sleep-Wake Cycle: Sleep, Insonmia, and the Orexin System (2013)
    Author's details featuring presentations and discussion from Andrew D. Krystal, Ruth M. Benca and Thomnas S. Kilduff
    Series title The journal of clinical psychiatry ; 74, Suppl. 1
    Collection
    Language English
    Size 20 S. : Ill., graph. Darst.
    Publisher Physicians Postgraduate Press
    Publishing place Memphis, TN
    Publishing country United States
    Document type Book ; Conference proceedings
    HBZ-ID HT017896812
    Database Catalogue ZB MED Medicine, Health

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    In stock of ZB MED Cologne/Königswinter

    Shelf markLoan statusLocation
    Zs B 108 -74,Suppl.1- verfügbar in Königswinter Königswinter

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  6. Article ; Online: Sleep therapeutics and neuropsychiatric illness.

    Krystal, Andrew D

    Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology

    2019  Volume 45, Issue 1, Page(s) 166–175

    Abstract: Alterations in sleep are extremely common in patients with neuropsychiatric illness. In addition, sleep disorders such as insomnia, obstructive sleep apnea, rapid eye movement sleep behavior disorder, and circadian rhythm disorders commonly occur at a ... ...

    Abstract Alterations in sleep are extremely common in patients with neuropsychiatric illness. In addition, sleep disorders such as insomnia, obstructive sleep apnea, rapid eye movement sleep behavior disorder, and circadian rhythm disorders commonly occur at a rate greater than the general population in neuropsychiatric conditions. Historically, sleep problems have been viewed as symptoms of associated neuropsychiatric disorders. However, there is increasing evidence suggesting a complex inter-relationship with possible bidirectional causality. The inter-relatedness of these conditions represents an opportunity for understanding mechanisms and improving clinical treatment. To the extent that sleep problems affect neuropsychiatric conditions, it may be possible to address sleep problems and have a positive impact on the course of neuropsychiatric illnesses. Further, some treatments for sleep disorders have direct effects on neuropsychiatric illnesses that may be unrelated to their effects on sleep disorders. Similarly, neuropsychiatric conditions and their treatments can affect sleep and sleep disorders. This article reviews available evidence on the effects of therapies for sleep disorders on neuropsychiatric conditions and also secondarily considers the impacts of therapies for neuropsychiatric conditions on sleep. Primary goals of this review are to identify gaps in current research, to determine the extent to which the cross-therapeutic effects of these treatments help to elucidate therapeutic or pathological mechanisms, and to assist clinicians in optimizing therapeutic choice in patients with sleep disorders and neuropsychiatric conditions.
    MeSH term(s) Antidepressive Agents/therapeutic use ; Antipsychotic Agents/therapeutic use ; Humans ; Mental Disorders/physiopathology ; Mental Disorders/psychology ; Mental Disorders/therapy ; Receptors, Melatonin/agonists ; Receptors, Melatonin/metabolism ; Sleep Wake Disorders/physiopathology ; Sleep Wake Disorders/psychology ; Sleep Wake Disorders/therapy
    Chemical Substances Antidepressive Agents ; Antipsychotic Agents ; Receptors, Melatonin
    Language English
    Publishing date 2019-08-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 639471-1
    ISSN 1740-634X ; 0893-133X
    ISSN (online) 1740-634X
    ISSN 0893-133X
    DOI 10.1038/s41386-019-0474-9
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  7. Article ; Online: Diagnosing and Treating Insomnia in Adults and Older Adults.

    Rosenberg, Russell P / Krystal, Andrew D

    The Journal of clinical psychiatry

    2021  Volume 82, Issue 6

    Abstract: Insomnia, the most prevalent sleep-wake disorder, affects 6% to 10% of adults. It may result in interpersonal and occupational problems and has a deleterious effect on quality of life. Patients may experience difficulty with sleep onset, sleep ... ...

    Abstract Insomnia, the most prevalent sleep-wake disorder, affects 6% to 10% of adults. It may result in interpersonal and occupational problems and has a deleterious effect on quality of life. Patients may experience difficulty with sleep onset, sleep maintenance, or both. Insomnia disorder is commonly comorbid with psychiatric, medical, and neurologic disorders, and insomnia and comorbid conditions have bidirectional relationships. Diagnosis should be based on patient interview, assessment with tools, and use of criteria. Selection of treatment for patients with insomnia should factor in efficacy for the patient's specific complaint as well as other features such as safety profile and abuse liability. Cognitive-behavioral therapy for insomnia is a first-line recommendation by guidelines, but some patients are unable or unwilling to try it or may not respond to it. Older adults with insomnia disorder require careful consideration of medications' risk-benefit profiles.
    Language English
    Publishing date 2021-09-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 716287-x
    ISSN 1555-2101 ; 0160-6689
    ISSN (online) 1555-2101
    ISSN 0160-6689
    DOI 10.4088/JCP.EI20008AH5C
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  8. Article: Human Anterior Insular Cortex Encodes Multiple Electrophysiological Representations of Anxiety-Related Behaviors.

    Lee, A Moses / Sturm, Virginia E / Dawes, Heather / Krystal, Andrew D / Chang, Edward F

    bioRxiv : the preprint server for biology

    2024  

    Abstract: Anxiety is a common symptom across psychiatric disorders, but the neurophysiological underpinnings of these symptoms remain unclear. This knowledge gap has prevented the development of circuit-based treatments that can target the neural substrates ... ...

    Abstract Anxiety is a common symptom across psychiatric disorders, but the neurophysiological underpinnings of these symptoms remain unclear. This knowledge gap has prevented the development of circuit-based treatments that can target the neural substrates underlying anxiety. Here, we conducted an electrophysiological mapping study to identify neurophysiological activity associated with self-reported state anxiety in 17 subjects implanted with intracranial electrodes for seizure localization. Participants had baseline anxiety traits ranging from minimal to severe. Subjects volunteered to participate in an anxiety induction task in which they were temporarily exposed to the threat of unpredictable shock during intracranial recordings. We found that anterior insular beta oscillatory activity was selectively elevated during epochs when unpredictable aversive stimuli were being delivered, and this enhancement in insular beta was correlated with increases in self-reported anxiety. Beta oscillatory activity within the frontoinsular region was also evoked selectively by cues-predictive of threat, but not safety cues. Anterior insular gamma responses were less selective than gamma, strongly evoked by aversive stimuli and had weaker responses to salient threat and safety cues. On longer timescales, this gamma signal also correlated with increased skin conductance, a measure of autonomic state. Lastly, we found that direct electrical stimulation of the anterior insular cortex in a subset of subjects elicited self-reported increases in anxiety that were accompanied by enhanced frontoinsular beta oscillations. Together, these findings suggest that electrophysiologic representations of anxiety- related states and behaviors exist within anterior insular cortex. The findings also suggest the potential of reducing anterior insular beta activity as a therapeutic target for refractory anxiety-spectrum disorders.
    Language English
    Publishing date 2024-03-07
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2024.03.05.583610
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  9. Article ; Online: Sleep Physiology and Neurocognition Among Adolescents With Attention-Deficit/Hyperactivity Disorder.

    Lunsford-Avery, Jessica R / Carskadon, Mary A / Kollins, Scott H / Krystal, Andrew D

    Journal of the American Academy of Child and Adolescent Psychiatry

    2024  

    Abstract: Objective: Few studies have characterized the nature of sleep problems among adolescents with attention-deficit/hyperactivity disorder (ADHD) using polysomnography (PSG). Additionally, although adolescents with ADHD and adolescents with sleep ... ...

    Abstract Objective: Few studies have characterized the nature of sleep problems among adolescents with attention-deficit/hyperactivity disorder (ADHD) using polysomnography (PSG). Additionally, although adolescents with ADHD and adolescents with sleep disturbances display similar neurocognitive deficits, the role of sleep in contributing to neurocognitive impairment in adolescent ADHD is unknown. This study investigated differences in PSG-measured sleep among adolescents with ADHD compared with non-psychiatric controls and associations with neurocognition.
    Method: Medication-free adolescents aged 13 to 17 (N = 62, n = 31 with ADHD; mean age = 15.3 years; 50% female) completed a diagnostic evaluation, 3 nights of ambulatory PSG, the Cambridge Neuropsychological Test Automated Battery, and subjective reports of sleep and executive functioning. Linear regressions covarying for age, sex, and pubertal status examined group differences in sleep indices, and partial Pearson correlations assessed relations between sleep and neurocognition.
    Results: Although adolescents with ADHD did not exhibit differences in PSG-measured sleep duration, awakenings, or latency (ps > .05) compared with non-psychiatric controls, they displayed lower slow wave sleep percentage (β = -.40) and non-rapid eye movement (NREM) electroencephalogram (EEG) delta power (β = -.29). They also exhibited greater stage 2 percentage (β = .41), NREM EEG sigma power (β = .41), and elevated self-reported sleep disturbances (ps < .05). Lower NREM EEG delta power, increased high-frequency power, and slower decline in NREM EEG delta power overnight were associated with poorer neurocognition among adolescents with ADHD.
    Conclusions: Adolescents with ADHD reported more sleep disturbances than non-psychiatric controls and exhibited differences in sleep stage distribution and NREM sleep EEG frequency. Sleep-EEG spectral indices were associated with impaired neurocognition, suggesting that physiological sleep processes may underlie neurocognitive deficits in ADHD. Future studies may clarify whether sleep plays a causal role in neurocognitive impairments in adolescent ADHD and whether interventions normalizing sleep improve neurocognition.
    Clinical trial registration information: Sleep Dysfunction and Neurocognitive Outcomes in Adolescent ADHD; https://clinicaltrials.gov/; NCT02897362.
    Diversity & inclusion statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.
    Language English
    Publishing date 2024-03-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392535-3
    ISSN 1527-5418 ; 0890-8567
    ISSN (online) 1527-5418
    ISSN 0890-8567
    DOI 10.1016/j.jaac.2024.03.005
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  10. Book: Long term issues in the treatment of sleep disorders

    Roth, Thomas / Krystal, Andrew D. / Lieberman, Joseph Aloysius

    (CNS spectrums ; 12,7, Suppl. 10 : Clinical information supplement)

    2007  

    Title variant Long-term issues in the treatment of sleep disorders
    Author's details authors Thomas Roth ; Andrew D. Krystal ; Joseph A. Lieberman
    Series title CNS spectrums ; 12,7, Suppl. 10 : Clinical information supplement
    Collection
    Language English
    Size 15 S. : Ill., graph. Darst.
    Publisher MBL Communications
    Publishing place New York, NY
    Publishing country United States
    Document type Book
    HBZ-ID HT015446204
    Database Catalogue ZB MED Medicine, Health

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    Zs A 5171 -12,Suppl.10- not available for loan Zeitschriften-Lesesaal

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